Hot Work Permit

Hot Work Permit

HSEOP-10-02
Seek an alternative/safer method if possible! This Hot-Work Permit is required for any operation that involves burning, welding, using an open flame, fire- or spark- producing tools, or that produces a source of ignition. This work includes, but is not limited to, welding, brazing, cutting, grinding, soldering, thawing pipe, torch-applied roofing. and chemical welding.
Project Name*
Date*

MonthDayYear
Date
Time Started*

Hour Minutes

AM/PM Option
Company*
Time Completed*

Hour Minutes

AM/PM Option
Location/Building/Floor*
Work to be done*
YesN/A
YesN/A
Requirements within 35 ft. (11m.) of hot work:
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
Requirements for hot work on walls, ceilings, or roofs:
YesN/A
YesN/A
Requirements for hot work on enclosed equipment:
YesN/A
YesN/A
YesN/A
Requirements for hot work fire watch and fire monitoring
YesN/A
YesN/A
YesN/A
YesN/A
YesNoN/A
I verify that the above location has been examined, the precautions marked on the checklist above have been taken, and permission is granted for this work.
Supervisor Authorizing Hot Work*

First NameLast Name
Supervisor Authorizing Hot Work Signature*

Clear
Fire Watch Name*

First NameLast Name
Fire Watch Signature*

Clear
*STOP* Revew Hot Work Permit with a member of PCL management. PCL management to complete below:
PCL Management Name*

First NameLast Name
PCL Management Signature*

Clear
Should be Empty:

Requirements within 35 ft. (11m.) of hot work: